A tiny tube of cream prescribed to him to treat a cold sore cost close to $4,000.

Miller, 59, of East Wakefield, has become somewhat of a local gadfly about burgeoning medical costs. The first time Foster's readers met Miller was last year when he contacted the newspaper about what he considered to be outrageous costs associated with his arthritis treatments. He was shocked when Wentworth-Douglass Hospital in Dover charged him $24,286 for the infusion of arthritis medication Remicade — a procedure that in previous years had only cost $6,000 per infusion.

This time, Miller contacted the paper about the cold sore cream. He said he was amazed when the hospital billed his insurance company $3,766 for the tiny tube.

In May Miller had a six-day stay at Wentworth-Douglass Hospital for an intestinal problem. While there, he asked doctor treat his cold sore. He was given a small tube of cream, Zovirax, which is a generic version of the drug, Acyclovir.

Although Miller said he got excellent care at Wentworth-Douglass, he said he was surprised to see the $21,044 hospital bill. After asking for an itemized copy of the bill, he learned that the 5-gram Zovirax tube cost $3,766.

By contrast, pharmacies typically charge a few hundred dollars for the cream, according to Miller's research through goodrx.com. He thinks that a few hundred dollars for the cream is expensive, too, it's far from the amount the hospital charged him.

Miller is insured through the Affordable Care Act, and has a plan through Anthem Blue Cross Blue Shield. The insurance company is paying $16,285 of the total hospital cost, while Miller is responsible for paying $4,758 out of pocket.

Regardless of insurance, Miller said high medical costs are something “we are all paying for.” Those with insurance, he said, are affected through higher premium costs.

After realizing how much his insurance company was charged for the small tube Zovirax, Miller met with a representative from the hospital's billing department. He said the process was frustrating, because the staff member told him she had no power to change the amount charged, and Miller wasn't given the opportunity to talk with someone who had that authority.

“I got good care at Wentworth-Douglass Hospital, but I can't get any understandable answers to my questions,” he said. “It's very frustrating ... when you ask a question they talk in riddles.”

According to Dawn Fernald, director of marketing and public relations for Wentworth-Douglass, the hospital's charge structure is managed by the fiscal team, with oversight by the executive team. The Wentworth-Douglass board of trustees, which represents the community, oversees all policies supporting the mission of the nonprofit hospital.

Fernald said Wentworth-Douglass Hospital has contracts with insurance companies, which pay a negotiated rate for services.

She also said the hospital offers discounts to patients who have no health insurance.

Fernald said the hospital charges include a mark-up on medication prices to cover costs associated with providing services, including covering costs for treating patients who cannot afford to pay for their care.

She said the mark-up also covers the cost of treatment for patients who only partially pay for their care, including Medicare and Medicaid patients, whose care is reimbursed by the federal and state government significantly less than the costs of providing care.

“On average we believe Wentworth-Douglass Hospital's overall charge structure is comparable with similar sized hospitals in our region,” said Fernald.

She noted the hospital cannot comment on a particular patient's treatment at the hospital, due to patient privacy concerns.

During a phone interview on Wednesday, Miller said if the hospital is including mark-up costs to cover patients unable to pay for their own care, that increased cost should be shown as a separate item on the bill.

It was not the first time Miller has been floored by his hospital bill. Foster's previously published an article about Miller in September, after the sticker shock he experienced when he was billed for arthritis medication.

Miller, who has been fighting psoriatic arthritis since 1989, discovered a “miracle drug” about 14 years ago that kept his pain at bay. For the first 13 years, the drug Remicade cost his insurance company about $6,000 per infusion. Miller would receive the infusion from his doctor at Seacoast Arthritis and Osteoporosis Center.

But in August 2013, the same procedure cost almost $25,000 at Wentworth-Douglass Hospital.

When Miller and Foster's Daily Democrat questioned the hospital officials about the high cost of the Remicade infusion, the hospital gave a response similar to what they had said about the tiny tube of cold sore cream. The cost of some items on patients' hospital bills are negotiated with insurance companies and are sometimes set higher to make up for all of the patients who can't pay anything for hospital care or who pay at a rate far below what their care actually costs.

That explanation aside, Miller said he intends to keep a close eye on his hospital bills. He hopes that through his stories, patients will take a closer look at their medical bills and become more aware of what is included in medication prices.